Carpal Tunnel Syndrome: Another Risk for Computer Users!

There are many such terms in the medical dictionary which are still unknown to us. But that's it! We may be aware of such symptoms and try to relate a health condition by these symptoms only. And going to a doctor will only allow us to know its name. For example, Carpal Tunnel Syndrome may be unknown to you, but you may have heard about or experienced the symptoms. You may have gone through embarrassing moments during which you may have faced trouble gripping or holding objects! You may also have gone through sleepless nights due a shooting pain from the wrist. When you turned up to your doctor, you came to learn about the name of the disease.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a problem that affects the wrist and hand. Carpal tunnel syndrome refers to a nerve disorder occurring at the wrist, causing pain, sensory changes and loss of function within the hand. It is one of the most common nerve entrapments in which the median nerve (an important nerve that originates from the cervical spine and connects with the thumb and all fingers of the hand, with the exception of the little finger) gets compressed at the wrist. Females are three times more prone for carpal tunnel syndrome than males.

What is Carpal Tunnel?

Our wrist has 8 small bones which are also known as carpal bones. These carpal bones, along with connective tissue, form a tunnel shape passage on the palmar side of the wrist, known as carpal tunnel. Several tendons and nerve pass through this narrow passageway. The tunnel protects the median nerve and nine tendons that bend your fingers. Carpal tunnel syndrome is characterized by the narrowing of the canal resulting in compression or entrapment of the median nerve.

The median nerve provides feeling and movement to the palm side of your hand and the thumb, index finger, middle finger, and part of the ring finger. In addition to controlling sensation in the hand, this nerve is also important to the general nerve function of the upper portion of the arm.

What are the Causes of Carpal Tunnel Syndrome? 

Carpal tunnel syndrome is the most common compressive neuropathy and is often caused due to direct trauma, repetitive use of wrist movements (more common in the work of computer professionals, musicians especially piano and violin players, and athletes), or anatomical anomalies. Repetitive use of the computer keyboard and the mouse is probably the most common cause of carpal tunnel syndrome. Interestingly, it is also commonly seen in the dominant upper extremity of athletes who participate in repetitive flexion and extension of the wrist such as in gymnastics and grip-intensive activities such as cycling, racket sports and archery. Other kind of work which can increase the risk of carpal tunnel syndrome include writing, driving, painting, sewing and assembly line work.

Carpal tunnel syndrome can also be seen in some of the medical conditions like diabetes, rheumatoid arthritis, thyroid disease, pregnancy and other conditions of excessive soft tissue swelling.

Signs and Symptoms of Carpal Tunnel Syndrome

The signs and symptoms vary from case to case and mainly depend on the extent of nerve compression or entrapment. Some of the classical complaints are:

• Sharp shooting pain from the wrist radiating throughout the course of the median nerve i.e. up to the arm and down to the hands.
• Tingling and burning sensation (sometimes numbness) in the radial part of the hand, especially in thumb, index and middle fingers. The pain gets worst at nights.
• One may even complain of clumsiness and weakness with grip related activities and frequent dropping of object.

Diagnosis of Carpal Tunnel Syndrome

The diagnosis and the severity of carpal tunnel syndrome are mainly determined by the patient's signs and symptoms. Some of the physical test like Phalen's sign is usually positive where the wrist is gently flexed as far as possible and the position is held for a minute. If this results in numbness in the median nerve distribution, then the test is positive. The quicker the numbness starts, the more advanced the condition. Electrodiagnostic study like nerve conduction studies can provide the confirmatory diagnosis.

Treatment of Carpal Tunnel Syndrome

• Give complete rest to your wrist. Avoid activities that increase pain.
• Medication to relieve pain and the anti-inflammatory medications may help decrease the synovitis (inflammation of the synovial membrane, the membrane which lines the joints) in carpal tunnel. Diuretics can be administered to resolve swelling, and sometimes corticosteroid injection administered into the carpal tunnel may assist in the resolution of symptoms.
• Splinting, at night and during activities that provoke increased symptoms, may be of help. A splint works by keeping the wrist in neutral position (straight) thereby preventing extreme movements that may narrow the carpal tunnel. But avoid constant wearing of this assistive device (splint) to prevent disuse atrophy (muscle wasting).
• If non-operative measures fail, surgical decompression is recommended involving the release of the transverse carpal ligament.

Preventive Measures

1. Modify activity in order to minimize repetitive stress movement. For example:
   • If possible, use alternate hand during activity to share the load.
   • Apply minimum pressure when typing on a keyboard, and replace the keyboard if it requires heavy keystrokes.
   • Alternate work activities so that your hand get rest from repetitive stress.
   • If you need to hold tools (including pencils and steering wheels) for long periods of time, grip them as loosely as possible.
   • Use lightweight tools. For instance, when choosing a pen for writing, avoid metal pens as they are heavy.
2. Use ergonomically designed tools and gadgets. For example, use a wrist rest to support your wrist while using a keyboard or mouse. You can also use a wrist brace to maintain the joint in a 'wrist-neutral' position. This decreases the pressure in the carpal tunnel.
3. Those returning to sports using a racket, club or bat should use a specially padded glove to protect the hand from shock and vibratory trauma.
4. Take frequent breaks from activities that require wrist movement. When typing on a computer keyboard, stop often to rest the hands, if only for a moment. If you use an equipment that requires you to exert a great amount of force or that vibrates, taking breaks is even more important.
5. Refrain from straining the wrist by bending it all the way up or down. Make sure that your keyboard is low enough (at elbow height or slightly lower) such that your wrists are in neutral position.
6. Do 5-minute warm-up exercises before starting work. For example:
   • Extend and stretch both the wrist and your fingers acutely as if they are in a hand stand position and hold till you count up to 5.
   • Make a tight fist with both hands and then bend the wrist down while keeping the fist and hold for the count of 5.
   • Hang your arms loosely at the side and shake them for a few seconds.
   • Straighten both the wrists and relax fingers for a count of 5.

Pursuing your hobby or staying committed to your profession is likely to be appreciated. But staying healthy, fit and fine is also necessary to continue with your dreams and goals. Repetitive stress injuries can shatter an artist's or an athlete's dreams! And so, it is very essential to "kill the cat on the first day".